Assessment of a Chronic Pain Clinic’s Compliance with Guidelines on Intrathecal Therapy for the Management of Pain

Abstract

Introduction/Aim: Intrathecal therapy (IT) is accepted as an effective way of treating chronic or cancer pain. The Polyanalgesic Consensus Conference (PACC, 2017) guidelines provide recommendations for: patient selection; assessment and psychological considerations; medication selection and starting doses; and educational requirements for implanting and managing IT. This study examined the PACC recommendations regarding IT delivery and evaluated if these recommendations are being followed in a tertiary chronic pain setting. Method: This study utilized a retrospective chart audit. A checklist was created using the PACC guideline consensus points to assess for compliance with the recommendations. Results: Charts from patients (n = 8 eligible; n = 7 with consent) were reviewed in the clinic. The majority of PACC recommendations were met. Patients had a diagnosis of either palliative cancer pain (n = 2) or a chronic non-cancer pain (n = 5) including failed back syndrome (n = 4), and radicular extremity pain (n = 1). There were 5 different drug combinations administered to patients: morphine + bupivacaine (n = 2); hydromorphone (n = 2); morphine (n = 1); baclofen + morphine (n = 1); baclofen + bupivacaine (n = 1). Patients’ original opioids were weaned after the 1st year of IT. Psychological screening was only conducted for the cancer patients. All health care professionals who refilled pumps had the appropriate training and all programming was conducted using an independent double check. Discussion/Conclusions: Chronic non-cancer pain was the main reason for IT delivery at our clinic. Although the majority of PACC recommendations were met there is room for improvement, for example psychological screening is not routinely done but should be considered for current and future patients.